Linkage 7/16: ED-STDs, Handoff Fumbles, and Avandia

With the constant drumbeat of advertisements for erectile dysfunction drugs, most of us can probably recite the list of precautions and side effects by heart by now. Though some of them inspire juvenile giggling (the one about “lasting more than 4 hours,” in particular), one warning is a head-scratcher: “does not protect against sexually transmitted diseases, including HIV.” Saying so always struck me as sort of a “duh” statement, but there had to be a reason for it to be there as part of the FDA-mandated laundry list of disclaimers for pharmaceutical advertising.

Indeed, there have been some studies that suggest men using ED drugs are at higher risk for STDs, which makes sense if you consider they will presumably be having more sex. But a new study in Annals of Internal Medicine of the STD rate in older men both before and after they receive a prescription for ED medication indicates that it’s not so much the drug, but the patient. The authors, which include Amee Kamdar of the University of Chicago Booth Graduate School of Business, analyzed the insurance claims of nearly 1.5 million men older than 40, comparing the rates of diseases such as HIV, chlamydia and syphilis in those who did or did not receive a prescription for an erectile dysfunction drug.

Those who sought treatment for ED did indeed have roughly twice the STD rate of the control population. But when those numbers were broken down into the year before ED prescription and the year after, the STD rate and risk was unchanged for those who received the drugs. That finding suggests that treatment of ED is not responsible for riskier sexual behavior, but people who engage in risky sexual behavior are more likely to seek treatment for ED. “The observed associated between ED drug use and STDs may have more to do with types of patients using ED drugs rather than a direct effect of ED drug availability on STD rates,” the authors conclude.

Clinically, the paper adds further argument for improved discussion of sexual issues with older patients, a topic covered previously on the blog regarding the research of our own Stacy Tessler Lindau. Studies have found that only 9 percent of adults between the age of 40 and 80 discussed sexual health with their physician during a routine visit, and opinion pieces (one called “Time for ‘the talk’ – again”) have argued that doctors should monitor the sexual practices of aged patients as much as younger ones. As the new study shows, when patients “talk to their doctor about ED,” the doctor should talk back about STDs.

What a Fumbled Handoff Looks Like

Last week, as expected, the Accreditation Council for Graduate Medical Education recommended further restrictions on the number of hours that medical residents can work. Under the new guidelines, first-year residents will not be allowed to work for longer than 16 consecutive hours (as opposed to the occasional 30-hour shift today) and more direct supervision by older residents and attending physicians will be required. The new guidelines are not yet settled – there’s a 45-day public comment period currently underway – but there is already plenty of research into the pros and cons of further restricting a resident’s time in the hospital (we’ll have more coverage of the guidelines debate soon).

An argument for the con side is that reduced resident hours would increase the number of patient hand-offs, the communication of patient information from the doctor going home to the doctor starting his or her shift. Vineet Arora, associate program director for the internal medicine residency at the Medical Center, studies the consequences of these hand-offs, and has written about the guidelines at her blog, FutureDocs. She’s also launched a side career in amateur filmmaking career on the topic – a professional video called “Hospital Handoffs for Intern Orientation” that recently won a contest for Best Professional Video of the Week. Check it out below:

If you enjoy a good social-media battle between “alternative medicine” peddlers and evidence-based debunkers, it doesn’t get much better than the recent feud between controversial UK nutritionist Gillian McKeith and Bad Science columnist Ben Goldacre.

Assistant professor of medicine Thomas Fisher is moving (for a year) from our emergency room to the White House. One of Fisher’s many accomplishments was to help start Project Brotherhood, an innovative way to bring health care to African-American men in urban communities.